Vitamin B12 deficiency is much more common than most health care practitioners and the general public realize. Data from the 3000 people that participated in the [Tufts University Framingham Offspring Study](http://www.ars.usda.gov/is/pr/2000/000802.htm) suggest that 40% of individuals between the ages of 26 and 83 have plasma (blood) B12 levels in the low normal range, 9% had outright deficiency, and 16% exhibited “near deficiency”.
In Canada, adult laboratory reference ranges for Vitamin B12 are as follows: one is technically deficient when their blood level is less than 138 pmol/L. The Lifelabs reference range for 19yrs of age or olds is 138-652 pmol/L. Japan and Europe have much higher ranges, with their lower limits being approximately 369 pmol/L. Why is B12 deficiency so under-diagnosed? B12 deficiency is often missed as it is not routinely tested by many physicians and the low end of the laboratory reference range is too low. Many B12 deficient people have so-called “normal” levels of B12.
Some experts have speculated that the acceptance of higher levels as normal in Japan and the willingness to treat levels considered “normal” in Canada explain the low rates of Alzheimer’s and dementia in Japan.
Humans are unable manufacture Vitamin B12 and must consume it in their diet on a regular basis. Vitamin B12 is a water-soluble nutrient that is naturally available by eating animal proteins, such as beef, poultry, fish, eggs, and dairy products. Plant-based foods do not contain vitamin B12.
Vitamin B12 absorption occurs primarily during the active digestion of animal proteins in the stomach and small intestine. Other factors including intrinsic factor, gastric acid, pepsin and R protein are needed for its absorption. Gastric acid (stomach acid) is needed to digest animal proteins. If an individual is not able to secrete sufficient amounts of stomach acid, they are not able to break down the protein in order to release the B12 found in food. Patients taking proton pump inhibitors for acid reflux are also at risk for developing B12 deficiency due to lower stomach acid production. Loss of intrinsic factor production results in pernicious anemia. These individuals must be treated with Vitamin B12 injections.
The liver is the primary storage organ for Vitamin B12. Deficiency symptoms of vitamin B12 may not develop for several years as the body draws from its liver storage.
Why is Vitamin B12 so important? Vitamin B12 works together with folate in the production of DNA and red blood cells. It is also involved in the production of the myelin sheath around nerves, and the conduction of nerve impulses. Myelin is the insulation that protects nerves and helps them to conduct messages. Long before anemia sets in, B12 deficiency causes several other problems, including fatigue, lethargy, weakness, memory loss, as well as neurological and psychiatric problems.
Who is at greatest risk for B12 deficiency?
· vegetarians and vegans
· those aged 60 or over
· individuals who regularly use PPIs or acid suppressing drugs
· diabetic taking prescription medications eg. metformin for their glucose levels
· individuals with Crohn’s disease, ulcerative colitis, celiac or IBS
· women with a history of infertility and miscarriage
Dr. Alene Falomo ND, RAc
_Disclaimer: _
_The information above is intended for informational purposes only. Always consult with your health care provider if this is suitable for you. _
